Provider Demographics
NPI:1588841928
Name:CARACCIO, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CARACCIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:SALE CREEK
Mailing Address - State:TN
Mailing Address - Zip Code:37373-7728
Mailing Address - Country:US
Mailing Address - Phone:423-332-8819
Mailing Address - Fax:
Practice Address - Street 1:211 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:SALE CREEK
Practice Address - State:TN
Practice Address - Zip Code:37373-7728
Practice Address - Country:US
Practice Address - Phone:423-332-8819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000029482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist